Évaluation de l'impact clinique et économique du développement d'un traitement pour la schizophrénie

Contexte : Les stratégies pharmacologiques pour traiter la schizophrénie reçoivent une attention croissante due au développement de nouvelles pharmacothérapies plus efficaces, mieux tolérées mais plus coûteuses. La schizophrénie est une maladie chronique présentant différents états spécifiques et définis par leur sévérité. Objectifs : Ce programme de recherche vise à: 1) Évaluer les facteurs associés au risque d'être dans un état spécifique de la schizophrénie, afin de construire les fonctions de risque de la modélisation du cours naturel de la schizophrénie; 2) Développer et valider un modèle de Markov avec microsimulations de Monte-Carlo, afin de simuler l'évolution naturelle des patients qui sont nouvellement diagnostiqués pour la schizophrénie, en fonction du profil individuel des facteurs de risque; 3) Estimer le coût direct de la schizophrénie (pour les soins de santé et autres non reliés aux soins de santé) dans la perspective gouvernementale et simuler l’impact clinique et économique du développement d’un traitement dans une cohorte de patients nouvellement diagnostiqués avec la schizophrénie, suivis pendant les cinq premières années post-diagnostic. Méthode : Pour le premier objectif de ce programme de recherche, un total de 14 320 patients nouvellement diagnostiqués avec la schizophrénie ont été identifiés dans les bases de données de la RAMQ et de Med-Echo. Les six états spécifiques de la schizophrénie ont été définis : le premier épisode (FE), l'état de dépendance faible (LDS), l’état de dépendance élevée (HDS), l’état stable (Stable), l’état de bien-être (Well) et l'état de décès (Death). Pour évaluer les facteurs associés au risque de se trouver dans chacun des états spécifiques de la schizophrénie, nous avons construit 4 fonctions de risque en se basant sur l'analyse de risque proportionnel de Cox pour des risques compétitifs. Pour le deuxième objectif, nous avons élaboré et validé un modèle de Markov avec microsimulations de Monte-Carlo intégrant les six états spécifiques de la schizophrénie. Dans le modèle, chaque sujet avait ses propres probabilités de transition entre les états spécifiques de la schizophrénie. Ces probabilités ont été estimées en utilisant la méthode de la fonction d'incidence cumulée. Pour le troisième objectif, nous avons utilisé le modèle de Markov développé précédemment. Ce modèle inclut les coûts directs de soins de santé, estimés en utilisant les bases de données de la Régie de l'assurance maladie du Québec et Med-Echo, et les coûts directs autres que pour les soins de santé, estimés à partir des enquêtes et publications de Statistique Canada. Résultats : Un total de 14 320 personnes nouvellement diagnostiquées avec la schizophrénie ont été identifiées dans la cohorte à l'étude. Le suivi moyen des sujets était de 4,4 (± 2,6) ans. Parmi les facteurs associés à l’évolution de la schizophrénie, on peut énumérer l’âge, le sexe, le traitement pour la schizophrénie et les comorbidités. Après une période de cinq ans, nos résultats montrent que 41% des patients seront considérés guéris, 13% seront dans un état stable et 3,4% seront décédés. Au cours des 5 premières années après le diagnostic de schizophrénie, le coût direct moyen de soins de santé et autres que les soins de santé a été estimé à 36 701 $ canadiens (CAN) (95% CI: 36 264-37 138). Le coût des soins de santé a représenté 56,2% du coût direct, le coût de l'aide sociale 34,6% et le coût associé à l’institutionnalisation dans les établissements de soins de longue durée 9,2%. Si un nouveau traitement était disponible et offrait une augmentation de 20% de l'efficacité thérapeutique, le coût direct des soins de santé et autres que les soins de santé pourrait être réduit jusqu’à 14,2%. Conclusion : Nous avons identifié des facteurs associés à l’évolution de la schizophrénie. Le modèle de Markov que nous avons développé est le premier modèle canadien intégrant des probabilités de transition ajustées pour le profil individuel des facteurs de risque, en utilisant des données réelles. Le modèle montre une bonne validité interne et externe. Nos résultats indiquent qu’un nouveau traitement pourrait éventuellement réduire les hospitalisations et le coût associé aux établissements de soins de longue durée, augmenter les chances des patients de retourner sur le marché du travail et ainsi contribuer à la réduction du coût de l'aide sociale.

Impact of Monetary Policy on Indian Economy in the Post-Reform Period

The present study was an attempt to analyze systematically the techniques of monetary control measures with its relevance and changing importance and to find out their effectiveness in the Indian context especially to achieve the thriving objectives of price stability and economic growth.There is definite and remarkable economic impact of monetary policy on Indian economy in the post-reform period. The importance of monetary policy has been increasing year after year. Its role is very relevant in attaining monetary objectives, especially in managing price stability and achieving economic growth. Along that, the use and importance of monetary weapons like Bank rate, CRR, SLR, Repo rate and Reverse Rate have increased over the years. Repo and Reverse Repo rates are the most frequently used monetary techniques in recent years. The rates are varied mainly for curtailing inflation and absorb the excess liquidity and hence to maintain price stability in the economy. Thus, this short-time objective of price stability is more successful on Indian economy rather than other long-term objectives of development.Monetary policy rules can be active or passive. The passive rule is to keep the money supply constant, which is reminiscent of Milton Friedman’s money growth rule. The second, called a price stabilization rule, is to change the money supply in response to changes in aggregate supply or demand to keep the price level constant. The idea of an active rule is to keep the price level and hence inflation in check. In India, this rule dominates our monetary policy. A stable growth is healthy growth.

Coastal regulation zone rules in coastal panchayats (villages) of Kerala, India vis-a` -vis socio-economic impacts from the recently introduced peoples’ participatory program for local self-governance and sustainable development

Coastal Regulation Zone (CRZ) notification was issued by the Ministry of Environment and Forest of Government of India in February 1991 as a part of the Environmental Protection Act of 1986 to protect the coast from eroding and to preserve its natural resources. The initial notification did not distinguish the variability and diversity of various coastal states before enforcing it on the various states and Union Territories. Impact assessments were not carried out to assess its impact on socio-economic life of the coastal population. For the very same reason, it was unnoticed or rather ignored till 1994 when the Supreme Court of India made a land mark judgment on the fate of the coastal aquaculture which by then had established as an economically successful industry in many South Indian States. Coastal aquaculture in its modern form was a prohibited activity within CRZ. Lately, only various stakeholders of the coast realized the real impact of the CRZ rules on their property rights andbusiness. To overcome the initial drawbacks several amendments were made in the regulation to suit regional needs. In 1995, another great transformation took place in the State of Kerala as a part of the reorganization of the local self government institutions into a decentralized three tier system called ‘‘Panchayathi Raj System’’. In 1997, the state government also decided to transfer the power with the required budget outlay to the grass root level panchayats (villages) and municipalities to plan and implement the various projects in their localities with the full participation of the local people by constituting Grama Sabhas (Peoples’ Forum). It is called the ‘‘Peoples’ Planning Campaign’’(Peoples’ Participatory Programme—PPP for Local Level Self-Governance). The management of all the resources including the local natural resources was largely decentralized to the level of local communities and villages. Integrated, sustainable coastal zone management has become the concern of the local population. The paper assesses the socio-economic impact of the centrally enforced CRZ and the state sponsored PPP on the coastal community in Kerala and suggests measures to improve the system and living standards of the coastal people within the framework of CRZ.

Análisis económico de las vacunas 10-valente y 13-valente contra neumococo: revisión sistemática

Introducción: Las vacunas clásicamente han representado un método económico y eficaz para el control y prevención de múltiples enfermedades infecciosas. En los últimos años se han introducido nuevas vacunas contra neumococo a precios elevados, y los diferentes análisis económicos a nivel mundial de estas vacunas no muestran tendencias. El objetivo de este trabajo era resumir la evidencia existente a través de los diferentes estudios económicos evaluando las dos vacunas de segunda generación contra neumococo en la población a riesgo. Metodología: En este trabajo se realizo una revisión sistemática de la literatura en 8 bases de datos localizadas en diferentes partes del mundo y también que tuvieran literatura gris. Los artículos fueron inicialmente evaluados acorde a su titulo y resumen, posteriormente los elegidos se analizaron en su totalidad. Resultados: Se encontraron 404 artículos, de los cuales 20 fueron incluidos en el análisis final. Se encontró que la mayoría de los estudios se realizaron en áreas donde la enfermedad tiene una carga baja, como es Norte América y Europa, mientras que en los lugares del mundo donde la carga es mas alta, se realizaron pocos estudios. De igual manera se observo que la mayoría de los estudios mostraron por los menos ser costo efectivos respecto a la no vacunación, y en su totalidad las dos vacunas de segunda generación mostraron costo efectividad respecto a la vacunación con PCV-7. Los resultados de los estudios son muy heterogéneos, hasta dentro del mismo país, señalando la necesidad de guías para la conducción de este tipo de estudios. De igual manera, la mayoría de los estudios fueron financiados por farmacéuticas, mientras en un numero muy reducido por entes gubernamentales. Conclusiones: La mayoría de los estudios económicos sobre las vacunas de segunda generación contra neumococo han sido realizados en países con un alto índice de desarrollo económico y patrocinados por farmacéuticas. Dado que la mayoría de la carga de la enfermedad se encuentran en regiones con un menor nivel de desarrollo económico se deberían realizar mas en estas zonas. De igual manera, al ser la vacunación un asunto de salud publica y con un importante impacto económico los gobiernos deberían estar mas involucrados en los mismos.

Mixed use urban regeneration at Brindleyplace, Birmingham and Gunwharf Quays, Portsmouth: an assessment of the impact on local and national economies

This independent research was commissioned by the British Property Federation. The report examines the local and national economic impact of two major, mixed use schemes in terms of tax revenue, household income, business rates and council tax and jobs creation. A regeneration balance sheet for each scheme is presented in the context of government policy and other related research. The report provides a comprehensive review of government policy and the role of retail and other land uses in regeneration. Highlighting the importance of national and local multiplier effects with detailed statistics drawn from a variety of sources, this fully illustrated colour research report builds up a detailed picture of economic impact of the mixed use regeneration schemes in the local economies of Birmingham and Portsmouth. The report will be of interest to property people, planners and all involved in regeneration and local economies.

Arable crop rotations under abiotic stress: a dynamic economic model

Break crops and multi-crop rotations are common in arable farm management, and the soil quality inherited from a previous crop is one of the parameters that determine the gross margin that is achieved with a given crop from a given parcel of land. In previous work we developed a dynamic economic model to calculate the potential yield and gross margin of a set of crops grown in a selection of typical rotation scenarios, and we reported use of the model to calculate coexistence costs for GM maize grown in a crop rotation. The model predicts economic effects of pest and weed pressures in monthly time steps. Validation of the model in respect of specific traits is proceeding as data from trials with novel crop varieties is published. Alongside this aspect of the validation process, we are able to incorporate data representing the economic impact of abiotic stresses on conventional crops, and then use the model to predict the cumulative gross margin achievable from a sequence of conventional crops grown at varying levels of abiotic stress. We report new progress with this aspect of model validation. In this paper, we report the further development of the model to take account of abiotic stress arising from drought, flood, heat or frost; such stresses being introduced in addition to variable pest and weed pressure. The main purpose is to assess the economic incentive for arable farmers to adopt novel crop varieties having multiple ‘stacked’ traits introduced by means of various biotechnological tools available to crop breeders.

A new governance perspective on port–hinterland relationships: the Port Hinterland Impact (PHI) matrix

We develop a new governance perspective on port–hinterland linkages and related port impacts. Many stakeholders in a port’s hinterland now demand tangible economic benefits from port activities, as a precondition for supporting port expansion and infrastructural investments. We use a governance lens to assess this farsighted contracting challenge. We find that most contemporary economic impact assessments of port investment projects pay scant attention to the contractual relationship challenges in port-hinterland relationships. In contrast, we focus explicitly on the spatial distribution of such impacts and the related contractual relationship issues facing port authorities or port users and their stakeholders in the port hinterland. We introduce a new concept, the Port Hinterland Impact (PHI) matrix, which focuses explicitly on the spatial distribution of port impacts and related contractual relationship challenges. The PHI matrix offers insight into port impacts using two dimensions: logistics dedicatedness, as an expression of Williamsonian asset specificity in the sphere of logistics contractual relationships, and geographic reach, with a longer reach typically reflecting the need for more complex contacting to overcome ‘distance’ challenges with external stakeholders. We use the PHI matrix in our empirical, governance-based analysis of contractual relationships between the port authorities in Antwerp and Zeebrugge, and their respective stakeholders.

Economic landscapes, what are they? an application to the Brazilian economy and to the sugar cane complex

In assessing the economic impact of a sector or group of sectors on a single or multiregional economy, input-output analysis has proven to be a popular method. . However, there has a problem in displaying all the information that can be obtained from this analytical approach. In this paper, we have tried to set new directions in the use of input-output analysis by presenting an improved way of looking at the economic landscapes. While this is not a new concept, a new meaning is explored in this paper; essentially, it will now be possible to visualize, in a simple picture, all the relations in the economy as well as being able to view how one sector is related to the other sectors/regions in the economy. These relations can be measured in terms of structural changes, production, value added, employment, imports, etc. While all the possibilities cannot be explored in this paper, the basic idea is given here and the smart reader can uncover all the various possibilities. To illustrate the power of analysis provided by the economic landscapes, an application is made to the sugar cane complex using an interregional inputoutput system for the Brazilian economy, constructed for 2 regions (Northeast and Rest of Brazil), for the years of 1985, 1992, and 1995.

The impact of corruption on the performance of state-owned companies: case of Petrobras Brasil

As empresas estatais são freqüentemente consideradas como componentes cruciais da economia de um país. Eles são responsáveis pela criação de vários postos de trabalho e proveem serviços essenciais que exigem um grande investimento de capital. Porém, em países com instituições fracas, onde a responsabilidade dos políticos é limitada e a gestão dos recursos financeiros das empresas estatais sofre pouco controle, os funcionários são muitas vezes tentados pela corrupção. Enormes quantidades de fundos públicos são facilmente desviados, e dinheiro que deveria ter sido investido nas despesas de capital, no pagamento de dívida da empresa ou no aumento do retorno para os acionistas, é usado para aumentar a riqueza privada de indivíduos ou para financiar ilegalmente partidos políticos. O desempenho da empresa sofre com essas alienações visto que parte dos lucros da empresa não são reinvestidos na empresa e dado que incentivos dos gestores estão desalinhados com os interesses dos acionistas. Petrobras, a maior empresa da América Latina em termos de ativos e receitas anuais, sofreu em 2014 e 2015 um escândalo de corrupção imenso, cujo impacto económico foi considerável, levando ao enfraquecimento da confiança de muitos investidores no Brasil após o evento. O escândalo expôs um extenso esquema de corrupção através do qual os contratantes foram conspirando para aumentar os preços de contratos de construção, com a aprovação da administração da Petrobras que pediu em troca ganhos pessoais ou fundos para o Partido dos Trabalhadores (PT). A exposição do escândalo na imprensa brasileira teve um grande impacto sobre a credibilidade da Petrobras: as contas da empresa estavam escondendo imensas irregularidades dado que a empresa tinha pago demais para os contratos de construção que não foram precificados no valor do mercado. Ao longo deste estudo, usamos o exemplo da Petrobras para ilustrar como a corrupção dentro empresas estatais prejudica o desempenho da empresa e como ela afeta as várias partes interessadas da empresa.

Economic valuation of collecting water to billing in the aspersion irrigated bean in the no tillage system and conventional crop

The law's project n.676/2000 approved the collecting of billing water for farmers in a maximum foreseen value of US$ 0.01 m(-3) of extracted water in the São Paulo State. As the irrigated agriculture is the activity that consumes more water, the farmers profitability can be affected. This work was to analyze the economic impact of billing water in the aspersion irrigated bean crop to consider the system of conventional production and no tillage system in the Paranapanema municipal district, São Paulo State, Brazil. The indicators used to analyze the economic results were unit variable cost, market price and unit profitability. The results showed that for the aspersion irrigated bean crop in conventional system, the participation of cost to the recourse water in cost variable totality was of 2.5% and in no tillage system the participation was of 2.2%. The fall of profitability just the billing water in conventional crop system and in no tillage system was US$ 0.01 kg(-1).

Integração de critérios técnicos, ambientais e sociais em estudos de alternativas locacionais para implantação de aterro sanitário

A Política Nacional do Meio Ambiente tem como objetivo a conciliação do desenvolvimento econômico e social com a qualidade ambiental, e dispõe de vários instrumentos que procuram contemplara capacidade de suporte do meio. Assim, a discussão sobre a localização das atividades é uma etapa importante para a avaliação da viabilidade ambiental de um determinado empreendimento, notadamente em processos de licenciamento ambiental. O trabalho apresenta uma abordagem metodológica para integração de critérios técnicos, ambientais e sociais em estudos de alternativas de localização de aterros sanitários, com especial atenção à interação entre os aspectos ambientais e os elementos fundamentais de um projeto (a saber, requisitos locacionais e concepção tecnológica), aplicado em um estudo de caso em São Carlos (SP). Como resultados principais, destacam-se o maior foco nos impactos significativos e a possibilidade de envolvimento de segmentos importantes da sociedade previamente à elaboração dos estudos ambientais.

Suriname: the impact of the May 2006 floods on sustainable livelihoods

Includes bibliography

Assessment of the damage caused by flood rains and landslides in association with hurricane Michelle, october 2001: implications for economic, social and environmental development

Preface This study was prepared for the Government of Jamaica following the significant physical damage and economic losses that the country sustained as a result of flood rains associated with the development of Hurricane Michelle. The Planning Institute of Jamaica (PIOJ) submitted a request for assistance in undertaking a social, environmental and economic impact assessment to the Economic Commission for Latin America and the Caribbean (ECLAC) on 14 November 2001. ECLAC responded with haste and modified its work plan to accommodate the request. A request for training in the use of the ECLAC Methodology to be delivered to personnel in Jamaica was deferred until the first quarter of 2002, as it was impossible to mount such an initiative at such short notice. This appraisal considers the consequences of the three instances of heavy rainfall that brought on the severe flooding and loss of property and livelihoods. The study was prepared by three members of the ECLAC Natural Disaster Damage Assessment Team over a period of one week in order to comply with the request that it be presented to the Prime Minister on 3 December 2001. The team has endeavoured to complete a workload that would take two weeks with a team of 15 members working assiduously with data already prepared in preliminary form by the national emergency stakeholders. There is need for training in disaster assessment as evidenced by the data collected by the Jamaican officials engaged in the exercise. Their efforts in the future will be more focused and productive after they have received training in the use of the ECLAC Methodology. This study undertakes a sectoral analysis leading to an overall assessment of the damage. It appraises the macroeconomic and social effects and proposes some guidelines for action including mitigating actions subsequent to the devastation caused by the weather system. The team is grateful for the efforts of the Office of Disaster Preparedness and Emergency Management (ODPEM), the associated government ministries and agencies, the Statistical Institute of Jamaica (STATIN), the Planning Institute of Jamaica and the Inter American Development Bank (IDB) for assistance rendered to the team. Indeed, it is the recommendation of the team that STATIN is poised to play a pivotal role in any disaster damage assessment and should be taken on board in that regard. The direct and indirect damages have been assessed in accordance with the methodology developed by ECLAC (1). The results presented are based on the mission's estimates. The study incorporates the information made available to the team and evidence collected in interviews and visits to affected locations. It is estimated that the magnitude of the losses exceeds the country's capacity to address reparations and mitigation without serious dislocation of its development trajectory. The government may wish to approach the international community for assistance in this regard. This appraisal is therefore designed to provide the government and the international community with guidelines for setting national and regional priorities in rehabilitation and reconstruction or resettlement programmes. A purely economic conception of the problem would be limited. A more integrated approach would have a human face and consider the alleviation of human suffering in the affected areas while attending to the economic and fiscal fallout of the disaster. Questions of improved physical planning, watershed management, early warning, emergency response and structural preparedness for evacuation and sheltering the vulnerable population are seen as important considerations for the post disaster phase. Special attention and priority should be placed on including sustainability and increased governance criteria in making social and productive investments, and on allocating resources to the reinforcing and retrofitting of vulnerable infrastructure, basic lifelines and services as part of the reconstruction and rehabilitation strategy. The Jamaican society and government face the opportunity of undertaking action with the benefit of revised paradigms, embarking on institutional, legal and structural reforms to reduce economic, social and environmental vulnerability. The history of flood devastation in the very areas of Portland and St. Mary shows a recurrence of flooding. Accounts of flooding from the earliest recorded accounts pertaining to 1837 are available. Recurrences in 1937, 1940, 1943 and 2001 indicate an ever-present probability of recurrence of similar events. The Government may wish to consider the probable consequences of a part of its population living in flood plains and address its position vis-à­¶is land use and the probability of yet another recurrence of flood rains. (1) ECLAC/IDNDR, Manual for estimating the Socio-Economic Effects of Natural Disasters, May,1999.

Infrastructure, integration and equity: The social impact of the health and public transportation infrastructure.

Academicians and practitioners generally agree that there is a positive correlation between more and better infrastructure and economic growth. From the broader perspective of development, attempts have been made in the literature to identify the different theoretical connections and the empirical patterns that link infrastructure to productivity, on the one hand, and those that link it to social inclusion and equity, on the other hand. Infrastructure contributes to development in different ways. The capital involved is not homogeneous, nor is its effect on the distributive aspects. Water and sanitation have a particularly strong association with the health of the general population and with infant mortality, early childhood health, learning abilities and the acquisition of labour skills. With respect to transportation, the reduction of costs and travel times has a direct economic impact on economic activities of production and domestic and international distribution. That infrastructure also has a social and distributive role to play by reducing the number of fatal accidents and serious injuries in the sectors that are naturally most susceptible to them, namely, the poor. Under the broad umbrella of infrastructure, we can include a number of facilities that make possible the provision of certain services. Some of these facilities require very significant fixed capital investments; some of them are residential, while others are not necessarily. What they all have in common is the existence of networks (transportation, wiring, pipelines) and a strong convergence of physical capital and/or technology, as well as the need for major investments in periodic maintenance.

The impact of climate change on the tourism sector in the Caribbean

The main aim of this study is to estimate the economic impact of climate change on nine countries in the Caribbean basin: Aruba, Barbados, Dominican Republic, Guyana, Jamaica, Montserrat, Netherlands Antilles, Saint Lucia and Trinidad and Tobago. A typical tourism demand function, with tourist arrivals as the dependent variable, is used in the analysis. To establish the baseline, the period under analysis is 1989-2007 and the independent variables are destination country GDP per capita and consumer price index, source country GDP, oil prices to proxy transportation costs between source and destination countries. At this preliminary stage the climate variables are used separately to augment the tourism demand function to establish a relationship, if any, among the variables. Various econometric models (single OLS models for each country, pooled regression, GMM estimation and random effects panel models) were considered in an attempt to find the best way to model the data. The best fit for the data (1989-2007) is the random effects panel data model augmented by both climate variables, i.e. temperature and precipitation. Projections of all variables in the model for the 2008-2100 period were done using forecasting techniques. Projections for the climate variables were undertaken by INSMET. The cost of climate change to the tourism sector was estimated under three scenarios: A2, B2 and BAU (the mid-point of the A2 and B2 scenarios). The estimated costs to tourism for the Caribbean subregion under the three scenarios are all very high and ranges from US$43.9 billion under the B2 scenario to US$46.3 billion under the BAU scenario.